Preventive Guidelines for adults
Last Updated and Reviewed: January 30, 2010
To all my patients:
I have created this handout as a way to summarize my advice regarding several important conditions and to explain my current ideas regarding preventive health issues. During the course of office visits, we often can cover preventive care, but it is impossible to go over all of the important preventive issues. A pre-scheduled routine physical is a good time to gauge your individual level of health in terms of preventable illness and ways to improve your health. The information I have put together is not designed to replace the individual evaluation of a face-to-face visit; rather it is designed to help you manage your health within these broad guidelines.
Jon E. Simon, M.D.
Making healthy dietary choices as often as possible can help you maintain healthy weight, prevent disease and just plain feel better. You can read more at my favorite nutritional website and we can discuss specifics during a routine preventive visit, but my basic dietary rules for adults, especially if you are overweight, are below:
1. Reduce total calories
2. Eat fruits and vegetables in abundance
3. Reduce starchy carbohydrates (white bread, enriched rice, potatoes, pasta) and substitute whole grains / fiber wherever possible.
4. Find lean sources of protein (lean meats, nonfat dairy, nuts)
5. Limit saturated fat (fatty cuts of meat, dairy fat, butter, many processed foods)
6. Remember rule #1
High Blood Pressure (Hypertension)
Elevated blood pressure is a strong risk factor for heart attacks, strokes, kidney failure, and dementia. For most adults, ideal blood pressure is 130/80 or less, and it is better to be even lower. Blood pressure normally will increase as we get older, so the more years you can keep your blood pressure low, the lower will be your risk of developing these complications over time. Blood pressure can be lowered without medication. This involves daily exercise, control of weight, limiting salt to 2000 mg per day, reduction of caffeine and alcohol. If your blood pressure is 140/90 or greater despite making these lifestyle modifications, you should be taking medication. There are dozens of medications available to treat hypertension, and we can always find a medication or combination of medications to control the pressure with minimal if any side effects. If you take medication for hypertension, you should see me at least twice per year to monitor the BP.
Type 2 Diabetes
Diabetes is a growing problem in our country and is strongly associated with being overweight. Diabetes causes damage to the blood vessels, leading to heart attacks, strokes, kidney failure, blindness, nerve problems, and many other problems. The way to prevent diabetes is to get control of weight through changes in diet. If you already have diabetes, whether or not you take medication, you can control your blood glucose by reducing caloric intake (especially carbohydrates) and increasing physical activity.
To best manage your diabetes, you should:
1. See me at every 3-6 months.
2. Monitor your glucose (discuss with me the frequency) at home; this helps you stay on top of any changes.
3. Have measurement of Hemoglobin A1C at least twice per year; have yearly measurement of urinary protein loss.
4. Aggressively lower your cholesterol with diet and/or medication.
5. See an ophalmologist (eye doctor) once a year for diabetic eye exam
6. Have regular foot care from a podiatrist.
7. Take a baby aspirin (81 mg) every day (Coronary Artery Disease is very common in diabetics).
Elevated blood cholesterol is another important risk factor for development of future heart disease and strokes. New guidelines based on clinical research have lowered the recommended levels of LDL (bad) cholesterol, but this is not for everybody; people with other risk factors should have much lower levels than otherwise healthy people. All adults should have cholesterol (including LDL, HDL, and triglycerides) measured about every five years; we can discuss the optimal goal for you during office visits.
Coronary Heart Disease
Heart attacks kill more people in the US than any other disease, caused by a sudden clot in a coronary artery filled with plaque. Coronary plaque develops over many years; risk factors include age, smoking, diabetes, hypertension, high cholesterol, overweight, sedentary lifestyle. Early detection is important, but there are no perfect tests to determine if you have silent heart disease. EKG’s and stress tests are not very useful for people who have no symptoms. Cholesterol testing and hs-CRP are blood tests that can help identify risk, but are not perfect either. Heart CT scans (though not often covered by insurance) are now available which can detect some of the plaque early; during the course of a routine physical we can discuss your cardiac risk and determine what tests can be useful.
Routine Gyn care and Pap Smears
I recommend yearly visits with a gynecologist for Pap testing (Cervical cancer screening) for all women over the age of 18 and any woman who is sexually active. Cervical cancer is entirely preventable via early detection. If you are over 60 and have always had normal Pap tests, then this can be done less often. If you have had a hysterectomy, then Pap testing is unnecessary, but you can discuss with your gynecologist. There is a relatively new vaccine to prevent the development of cervical cancer (when given to teenage girls before they become sexually active; please discuss with me during a routine well visit if you are interested.
Women over the age of 40 should have regular mammograms, either yearly or every other year; over age 50, mammograms should be yearly. Breast cancer is now one of the most curable forms of cancer if it is detected early. If you have a gynecologist, then she should perform a breast exam yearly. Please notify me if you do not have a regular gynecologist, and I will do a breast exam as part of a routine physical. There is much debate over the benefit of breast self exam; for some women it causes too much worry. If you don’t feel comfortable with monthly self exams, then please make certain you are up to date on physician breast exams and mammograms. If you notice any lump in your breast, please call for a same day appointment.
Routine screening colonoscopy has revolutionized screening for this devastating disease. I no longer recommend yearly testing for occult (hidden) blood in the stool. These tests have too many false positives and false negatives to be useful. Rather, I recommend screening colonoscopy for every adult over the age of 50 to be done every ten years. If a close family member has had colon cancer, you should start screening sooner than age 50. Please contact our office for the name of a gastroenterologist if you have not had this screening test.
Bones get weaker as we get older, and are more succeptible to fractures. The density and strength of our bones increases only until about age 25, at which point the decline begins. Adequate daily calcium intake (1200-1500mg) can help prevent, or at least minimize, this decline. I recommend periodic DEXA (bone density) testing beginning for women around menopause. This test should be done ever 2-5 years, depending on your level of bone density. At this point, I do not recommend routine bone density testing for men, though some newer research suggests men may be at just as high risk as women. Stay tuned….
Skin cancer / melanoma
Any kind of suntan represents damage to the skin from the sun. Any sunburn during childhood puts you at risk of skin cancer later in life. Please wear sunscreen as often as you can, but especially if you are going to be outdoors for an extended period of time. Wearing long sleeves and a hat can protect you from the sun’s rays as well. If you have a personal or family history of melanoma, you should see a dermatologist once per year. Otherwise, you should see me if you notice a suspicious skin spot. Remember the ABCD’s of skin cancer: Asymmetry, irregular Borders, Color which is uneven, Diameter more than 6 mm. I want to examine any mole with any of those features
All men over the age of 50 should be screened for prostate cancer about once per year. The combination of PSA (blood test) and prostate exam (rectal exam) can effectively identify early prostate cancer. PSA by itself is not accurate enough, nor is prostate exam by itself. African-Americans and any man with a family history of prostate cancer should be screened beginning at age 40.
Other Routine Preventive Health Issues
I recommend the following routine vaccines:
1. Tetanus vaccine every 10 years as an adult. Before age 65, this vaccine is combined with pertussis (whooping cough) vaccine as well.
2. Annual influenza vaccine for everyone, especially if you are over 50, or have asthma, diabetes, or any chronic immune illness. Even if you are under 50 and healthy, you can get influenza vaccine if you want to.
3. Pneumovax (Pneumonia vaccine) for anyone over the age of 65, or anybody with chronic lung disease or any problem of the immune system. A booster is recommended after five years if you received your dose before age 65.
4. Hepatitis B vaccine if you are sexually active, use IV drugs, or have chronic liver disease
5. Shingles vaccine should be given once after the age of 60. I don't stock this vaccine, but it can be given by many local chain pharmacies.
There are numerous other preventive issues which I will mention here; some of these guidelines may seem like common sense, but can following healthy habits can improve your health and reduce your chance of preventable illness.
1. Tobacco. Smoking is bad for you. There, I said it. If you like smoking and don’t want to stop, please let me know and I will only bother you a little. If you are ready to quit, please set up an appointment to review options. There are medications and non-medication approaches to help you be successful.
2. Seatbelts. Wearing a seatbelt will greatly reduce your chance of dying in a car accident. You and all your passengers should wear a seatbelt.
3. Vitamins and Supplements. A regular daily multivitamin is a good idea; with very few exceptions, there is no evidence that other supplements and herbs or homeopathy will improve health, prolong life, or provide relief from disease. The supplement industry is a very profitable venture, and these unregulated companies are out to make a profit, not necessarily to improve your health. My recommendation is to not waste your money on supplements. Nonetheless, I realize that many people take supplements and herbs for various reasons. Please let me know what herbs, vitamins, and over the counter pills you choose to take; some can have health consequences, drug interactions, etc.
4. Exercise. Adults should exercise at least 4 days per week for at least 30 minutes. I strongly encourage any form of exercise, including walking, running, biking, swimming, or any activity that you enjoy. Daily physical activity will not only make you feel better and maintain a healthy weight, but also will reduce stress, prevent many diseases and prolong your functional capacity later in life. I realize that it is difficult to prioritize exercise amidst our busy schedules, so if you find this difficult, please realize that even some exercise is better than none at all. Some activity during the day, even if it wouldn't qualify as vigorous exercise, is still beneficial, and much better than just sitting around.
5. Alcohol. How much is too much? Most experts agree less than 1-2 drinks per day is safe for men, and less than ½ to 1 drink per day for a woman.
6. Helmets. If you ride a motorcycle or a bicycle, you should wear a helmet. The brain is the most important organ to protect.
7. Illicit drugs. I recommend against using street drugs, including marijuana, cocaine, heroin and others. A growing number of people are addicted to prescription narcotics or other pills as well. If you think you may have a problem with drugs or alcohol, please let me know. I do not look down upon you, and will offer help in any way I can.
8. Fire safety. All homes should have working smoke alarms, and a fire evacuation plan. If you have an oil furnace, you should also install a carbon monoxide detector.
9. Safe sex practices. If you are sexually active, and not in a mutually monogamous relationship, then condoms should be used 100% of the time, to prevent transmission of sexually transmitted infections, in addition to prevention of unwanted pregnancy. If you are concerned about STD’s please schedule an appointment for screening.
10. Advanced Medical Directives. I recommend that adults have a “living will” which states in writing the details of your wishes about end-of-life care. This is an important topic, but often difficult to discuss. Please let me know about your wishes during a routine appointment, and please share your wishes with close family members.